Individual
DEIDRA HENDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.N.
Contact information
Practice address
48025 COUNTY STREET 2580, APACHE, OK 73006-9708
(580) 450-3257
(580) 588-2289
Mailing address
PO BOX 224, APACHE, OK 73006-0224
(580) 450-3257
(580) 588-2289
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R0074963
OK
Other
Enumeration date
04/05/2016
Last updated
04/05/2016
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